Low previous cardiovascular risk of patients with ST-elevation myocardial infarction.

Background: Myocardial infarction is frequently the initial form of presentation of coronary artery disease (CAD). Systemic Coronary Risk Estimation (SCORE) risk tables are used in primary prevention and provide an estimate of cardiovascular (CV) risk through known risk factors. The aim of this study was to evaluate the performance of the SCORE, calculated using data previous to the event, to estimate CV risk of a population of patients presenting with ST-elevation myocardial infarction (STEMI) as the first manifestation of CAD.

Methods And Results: From a prospective registry including 3056 patients with STEMI subjected to coronary angiography between 2004 and 2014, 1628 patients with STEMI as the first manifestation of CAD were included after the exclusion of patients with known CAD (n=748, 24.5%), patients with high-risk equivalents (n=930, 30.4%), and patients with normal coronaries (n=57, 1.87%). The individual risk profile was calculated using data previous to the event and patients were classified into three established subgroups: low risk (SCORE<5%; n=1162, 71.4%), high risk (SCORE 5-10%; n=409, 25.1%), and very high risk (SCORE≥10%; n=57, 3.5%).

Conclusion: In a population of patients with STEMI as the first manifestation of CAD, the CV risk stratification with the SCORE risk charts, if calculated before the event, would classify as low risk more than two-thirds of the patients (71.4%) and only 3.5% would be classified as very high-risk patients. The high prevalence of low-risk patients indicates the current challenge of CV risk stratification, underlying the need for additional tools in primary prevention to better identify patients at risk.